The Utila blog is about health, behavioral health and patient-centered technologies. At Utila we believe that better communication leads to more engaged patients, better treatment outcomes, and reduced healthcare costs.

Friday, November 18, 2016

Evidence Based Treatment for Super Utilizers

It seems obvious that in behavioral health we should use treatments that are tried and true. Hence the push for behavioral health systems and clinicians to use treatments that have strong empirical support like cognitive behavioral therapy (CBT). This is fine and good.

And naturally we want our clinicians to be trained in best practices and payers want to see that patients are being provided first lines of treatment. Also fine and good.

Here's the but...

Super utilizers would never meet the criteria to participate in the clinical studies that evaluated these evidence based treatments in the first place. Providers (especially Medicaid providers) are ill equipped to treat individuals with multiple comorbidities in addition to complex environmental and socioeconomic stressors. Rarely is it so simple as providing a manualized treatment that solves a specific clinical condition in isolation. I wish!

So what's the alternative?

Of course we shouldn't throw evidence-based treatments out the window. Rather we have to support our clinicians by providing them with better and more sophisticated tools to treat patients with multiple clinical and environmental issues. We have to adapt the tools that we know work, like CBT, to reach a broader base than they were originally developed for.

Take mindfulness-based stress reduction or MBSR which has demonstrated impressive clinical outcomes. We know that mindfulness works, but if we take a closer look at the clinical protocol, participants are required to commit to an hour per day of formal meditation practice. As a provider, when I think about some of the super utilizer patients that I have worked with, the actual clinical protocol as defined by MBSR is a non starter with many of these patients!

So the question is how do we repackage MBSR and other evidence based interventions so that they reach more patients, including super utilizers? And how do we equip our providers with the tools they need to deliver these new interventions effectively?

At Utila, we believe the answer HAS to include patient-centered technology using patients' preferred modes of communication including SMS text. And at the end of the day providers' and patients' voices need to be heard so that we can refine these next generation treatment interventions. This is a problem we're passionate about solving, and we're eager to partner and collaborate with others who share our vision!